Social Care

Melanie Onn Excerpts

Wednesday 25th April 2018 Commons Chamber

[Anna Turley]

My hon. Friend raises an important point. Much has been said today about the prestige of the sector and that suggestion would go a long way to addressing that.

[Melanie Onn (Great Grimsby) (Lab)]

To follow up on the issue of training, it is important that people who are going into people’s homes to care for them or who care for people in a home setting have all the training they require to perform the duties that are expected of them. Too often, they are not given the training they need and are expected to do far more than they are qualified to do.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I believe there is a voluntary time limit of seven minutes. We are in danger of spoiling that. If we do, I will have to bring in a time limit of about 5 minutes. I do not want to do that, so I need Members to help me ensure that everybody gets an equal amount of time.

Emergency Services and New Estates

Melanie Onn Excerpts

Tuesday 27th March 2018 Westminster Hall

[Jenny Chapman]

I agree, and I am grateful to see my hon. Friend and other hon. Members present. I regret not asking for more time, because conversations that I have had with hon. Members in the lead-up to the debate have indicated that there is substantially more interest in the problem than I had realised.

Like many young couples, Andy and Charlotte had recently moved into their new property. It was their first home together, in which they dreamt of starting a family. On the night of 11 February 2017, Charlotte found herself in a situation she had never thought she would encounter. Her partner Andy, a fanatical cyclist, had just completed a 50-mile bike ride—he had ridden more than 1,000 miles in the previous year. After settling down for the night, Andy became unwell, and it was later confirmed that he had suffered a cardiac arrest. Charlotte called 999, proceeded to carry out CPR on her husband and spoke to the operator.

Charlotte told the operator that the ambulance crew would need to access her estate via a particular road. Unfortunately, although a property may have a postcode, many homes on the 40,000 unadopted roads on new estates are not visible on the systems used in emergency or first responder vehicles.

As I later found out by sending freedom of information requests to all ambulance trusts, in many cases, emergency vehicle sat-navs are updated only every six to eight weeks on average. Even when updated regularly, the information used to update the sat-navs is only as up to date as that provided by Ordnance Survey. There is no standard process across ambulance trusts or other emergency services. One trust stated that it is

“aiming to update a minimum of every 6 months but sooner if practically possible”.

Thanks to Charlotte’s directions, the paramedics were in the correct area, but the ambulance ended up driving down a lane that led to a river bank with no bridge across to her estate. Charlotte could see the ambulance, but its way was blocked by a five-foot wall on one side and a six-foot fence on the other. The paramedics had no choice but to reverse back up the lane for three quarters of a mile, causing further significant delay.

Charlotte heroically gave CPR to her husband and directions to the operators. Thirty minutes after she dialled 999, paramedics finally arrived on the scene and took control. Their best efforts to resuscitate Andy tragically came too late to save his life.

I applied for the debate because in different circumstances, we would not be having this discussion. It is often the case that, through awful events, faults are identified and can be dealt with. Although nothing can bring Andy back, Charlotte would like his story to be used to stop similar incidents happening in future.

About 200,000 homes were built in 2017. Many hon. Members have such developments in their constituencies, so it is important that we get this right.

[Melanie Onn (Great Grimsby) (Lab)]

Has my hon. Friend given any consideration to earlier action? Perhaps local authorities could better engage with health services, ambulance services and Ordnance Survey at the planning stage.

[Jenny Chapman]

Yes. As I will go on to explain, the problem is that there is no standardised approach, but there ought to be.

At the moment, ambulance trust mapping databases are provided under the national public sector mapping agreement. Under the terms of that agreement, Ordnance Survey releases updates free of charge every six weeks, but it is reliant on local authorities or developers submitting a request. As I mentioned earlier, emergency vehicle GPS systems are updated only every six to eight weeks on average, when they receive a routine mechanical service—though even that is not the case for all trusts. There is potential for delay at several stages of the process.

There is no consistency between local authority areas, and I have found idiosyncratic practices. In one local authority, the ambulance trust said that its way of dealing with the problem was to send its officers along to planning meetings in person so that it could be promptly informed of new developments. Surely we can find a better way of doing it than that.

If different systems operate across emergency services, we miss the opportunity to find a much more collaborative approach. I ask the Minister whether, given the technological advances at our disposal, an auto-upgrade solution is possible. Most of us have self-upgrading smartphones. With lives at risk, surely we must be able to find some kind of new solution along those lines.

The practices of local authorities and developers could be standardised to ensure that they request that Ordnance Survey carries out work when at least one property on a development is occupied, even if the development is not completed and the roads are not adopted. If the postal service and Amazon can find a property such as Charlotte and Andy’s to deliver mail, could procedures and knowledge not be shared in a joint approach?

A good example can be found in the north-west. The North West Ambulance Service Trust response to my freedom of information request stated:

“On new large developments the map is often blank…so the team add descriptive route notes to aid crews. For example, take the first left on to Flower Crescent off New Bridge Street”,

which might be an existing road. That highlights that different and better ways of developing new mapping systems could save such incidents from occurring.

In speaking on Charlotte’s behalf, I want to make it absolutely clear that what happened was in no way the fault of the paramedics or the operator. It is a flaw in the complex system that our emergency services work with. I have called the debate to make the Minister aware of the problem in the hope that he will commit to act promptly to find the best way to resolve it.

To give some additional information, we sent an FOI request to every ambulance trust. I can provide the Minister with the responses we received, so he can see the disparity for himself. London Ambulance Service said that it had recorded 17 of these occurrences during the last three years, whereby crews had encountered difficulties in locating new build properties. The Welsh Ambulance Service recorded four occurrences, but most ambulance trusts just did not record incidents at all, so we do not know how frequently they are happening.

Given the risk to our constituents and the number of new developments, and the fact that this is a completely solvable problem—it does not require additional resource, and requires only someone’s attention to look at the process and organise it—the Minister could commit to action today.

--- Later in debate ---

[The Minister for Health (Stephen Barclay)]

It is a pleasure to serve once again under your chairmanship, Mr Hollobone. I commend the hon. Member for Darlington (Jenny Chapman) for securing this debate. First, I extend my sympathies and, I am sure, the sympathies of all those present, to Charlotte for her loss.

The hon. Lady has used a Westminster Hall debate in the finest tradition, by raising an issue that I was not previously briefed on to the degree that I am now as a consequence. There is ongoing work on it, which I will happily update her and the rest of the House on. She has highlighted an issue that affects all of us in all our constituencies, because as the Government seek to build more housing, this issue will grow across constituencies and have greater reach. Also, as she rightly said, it applies not only to the ambulance service but to the blue-light fraternity as a whole, so I very much commend her for raising the issue.

The hon. Lady showed that she already has an in-depth knowledge of some of the challenges caused by the time lag in how systems are updated. However, I am pleased to reassure her that there is work ongoing in this area specifically. The Department of Health and Social Care is centrally procuring new control room and vehicle communications systems for NHS ambulance trusts, which will be able to update wirelessly. There are questions as to the frequency of those updates, which relates to the point that my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) made about the flow of information from the Department for Communities and Local Government, the planning system and the Ordnance Survey. The ongoing work in the Department is looking at how the central procurement of information into control rooms can ensure that there is a better supply of data about new housing of the sort that the hon. Member for Darlington referred to.

Although the effective deployment and maintenance of GPS systems is, as I am sure the hon. Lady recognises, an operational matter, they are centrally funded systems. As she said, the Department for Business, Energy and Industrial Strategy sponsors the Ordnance Survey, which owns the public sector mapping agreement. That is a 10-year agreement entered into in 2011, which provides the geographical datasets that are used centrally. That information includes data to advise emergency services of the best locations in which to position their vehicles at any given time of the day, based on historic patterns of where they are most likely to be needed. Updates to those datasets are available every six weeks, and the Ordnance Survey is engaged with the emergency services on their specific needs and on whether increasing the frequency of that supply of information would be useful.

As the hon. Lady may be aware, there has recently been a trial, which concluded at the end of February, and the Ordnance Survey is currently analysing the findings of that work in order to develop options. The North West Ambulance Service—not the north-east service—was part of the initial trial, and it has fed its experience into that process. So there is ongoing work on central procurement and also on that trial, examining the issues that the hon. Lady has brought before the House today.

I recognise that the frequency of the updates has been variable, and the hon. Lady was quite right to draw the House’s attention to that. As part of the ambulance radio programme, a replacement mobilisation application has been procured for use in ambulance vehicles across all the NHS ambulance trusts in England. Under that contract, the supplier is required to provide mapping software and an embedded satellite navigation system to assist ambulance crews with the prompt location of emergency incidents. The contract also requires the supplier to provide automated, over-the-air map and satellite navigation updates on a quarterly basis, and to report the current versions of the maps being used for audit purposes.

I am sure the hon. Lady will join me in welcoming those developments. The new system will make up-to-date map and satellite navigation data more readily available to all emergency crews.

[Melanie Onn]

Has the Minister given any consideration to my hon. Friend’s concern about the lack of data that has been collected, and would there be any benefit to collecting that information, to make sure that the new system that will come on-stream is distinctly preferable to the old system?

[Stephen Barclay]

The hon. Lady makes a pertinent point; I was just going to come on to the issue of timing. There are two aspects to this process: the updating of control systems and the updating of vehicles. Different work is happening on both those things, but she suggests a third point to be considered—the data that feeds into those two systems, and the time period between housing development coming on-stream and the systems being updated. Those are the points that I take from her remarks and they will inform further discussions with Government as part of the pilots and the other work that is already under way.

The North East Ambulance Service has improved the processes for updating its mapping system, and I suspect that much of the credit for that goes to the hon. Member for Darlington for raising the issues that she has raised. The trust has upgraded its computer-aided dispatch system and control room mapping updates, and they can now be installed without affecting the wider system, which was one of the difficulties previously. The upgrade allows for six-weekly additions of notifications received from local authorities when new housing estates are opened, better equipping 999 dispatchers to guide ambulance crews to locations when they need assistance. Other ambulance trusts have similar arrangements for updating the control room systems that are currently in place.

The North East Ambulance Service Trust has also improved the frequency of its updates to its individual vehicle mapping systems, moving from an annual update to one every six months. Again, that is not the timeline that the hon. Lady quite rightly highlighted, but it does show that there is a focus on this area, and it shows the direction of travel on improvements.

We recognise that there is variation in the updating of ambulance vehicle systems. That is driven by the fact that different systems are in place in different services. For example, some trusts are able to update their ambulances through wi-fi, while others require lengthy manual updates to be performed during regularly scheduled vehicle servicing. Following this debate, one of the issues that I will be keen to explore further with officials is what will happen as we procure new vehicles. We will consider what can be done to address the issues that the hon. Lady raised today.

The common ambition among ambulance trusts is to upgrade vehicles in a six-month rotation, and we will improve on that rate further with the new national solution. Some trusts have also taken the approach of providing personal-issue tablets with online-style mapping, which can be used by ambulance crews as a back-up to the vehicle’s satellite navigation system and use the most recent commercially released maps.

A range of work is under way within the ambulance service on changes to how calls are triaged and processed, which will address some of the imbalance between rural and urban areas that we have seen in the past. There is work on changes to control room systems and on upgrades. I will happily take forward the point raised by the hon. Member for Great Grimsby (Melanie Onn) about the timescales and about what work can be done and is being done on that.

The hon. Member for Darlington deserves credit within her own trust area for raising these issues as a consequence of the tragedy that Charlotte has had to endure. There is a focus within ambulance trusts across England on the need to ensure that upgrades are made in a more timely fashion. The hon. Lady has rightly brought that point before the House, and I will continue to take it forward with officials in the weeks and months ahead.

Question put and agreed to.

East Midlands Ambulance Service

Melanie Onn Excerpts

Wednesday 21st February 2018 Westminster Hall

[Ruth George]

To be honest, when I was at East Midlands ambulance HQ, the waiting time at Lincoln hospital was seven hours for patient handover. Unfortunately, in those situations ambulances are diverted to where patients who need help urgently can get the care they need. Part of the problem is the handover times, particularly at Lincoln.

The longest 10% of urgent responses took more than 82 minutes, which is twice the target of 40 minutes. For category 3 urgent calls, 10% of East Midlands calls took more than three hours 22 minutes against a target of two hours. In practice, that means that people who are very seriously ill or in pain are waiting hours and hours for an ambulance. My constituent, Debbie, contacted me on Saturday night at 10 o’clock. Her 82-year-old mum had a hairline fracture of her hip. It had not been diagnosed, and suddenly her mum found herself in excruciating pain and unable to move. Despite calls to 111 and then 999, there was simply no ambulance available.

It was only when Debbie called at midnight and said that her mum was passing out of consciousness due to exhaustion and pain that the call was upgraded to category 2 and the ambulance arrived 20 minutes later. By then her mum had been waiting in agony for more than nine hours. The ambulance crew apologised, but they had been on more urgent calls the whole time. Debbie and many other constituents have contacted me to ask, “Why is this happening?”

A few weeks ago, I visited the ambulance control centre at Nottingham to see the management of East Midlands ambulance calls across the whole region. It was a Friday lunchtime, but even at that time the emergency calls and urgent calls were stacking up. I listened in as people were calling back to find out how long an ambulance would take. Health professionals, families, neighbours and shop assistants were all caring for someone who was seriously ill and needed an ambulance. They were undergoing hours of pain, worry and uncertainty.

From that experience and from speaking to local paramedics and East Midlands ambulance managers, it seems that there are four key reasons for the issues. The first is our geography. East Midlands ambulance covers a huge area, from the border of Manchester in my constituency to the shores of Lincolnshire. It has the second lowest population density in England after the south-west, but also the second-lowest investment in transport infrastructure after the north-east. It is not only a large region; it is hard to get around.

Secondly, when ambulances do get their patient to hospital, they encounter some of the longest waits for transfers. In 2015-16—the latest figures that we can obtain—only 44% of handovers in the east midlands were completed within 15 minutes, compared with 58%, on average, across England. This winter, handover times in some hospitals have got much worse. At my constituents’ local A&E at Stepping Hill, ambulances were waiting for more than three hours. At Lincoln hospital, it was more than seven hours. When vulnerable people are waiting in severe pain for an ambulance, to have them queued up outside hospitals unable to hand over their patients is incredibly frustrating.

The third issue is the level of demand. In the east midlands, the number of responses rose from 222,000 in 2011-12, to 335,000 in 2016-17—an increase of more than 50%.

[Melanie Onn (Great Grimsby) (Lab)]

I thank EMAS for coming to meet with the northern Lincolnshire and Lincolnshire group of MPs last year, when we were concerned about ambulance provision. Subsequent to that, paramedic Lee Hastie gave an account to the local Grimsby Telegraph about his experiences, particularly in relation to demand for ambulance services, saying that most of his calls on an everyday basis now relate to drug and alcohol abuse. Does my hon. Friend consider that cuts to local government drug and alcohol services have gone some way to increasing the demand on our ambulance services? They are essential services that, at a community level, simply are not there any longer.

[Ruth George]

I would certainly concur with that statement. It is one of many areas in which the lack of services at an urgent level is creating an increased demand—but in no way has East Midlands ambulance service’s funding increased to cover that level of demand, as we will see later.

Part of the increase is due to the 111 service. We saw the chaos that 111 created when the coalition Government brought it in to replace Labour’s NHS Direct with a much cheaper service with hardly any clinicians. Things have improved, but at busy times the 111 service still does not have enough qualified staff to make decisions, so the call-handlers have to be risk-averse, follow their script, and call out an ambulance if there is any doubt at all.

We have seen the number of 111 calls resulting in an ambulance call-out gradually increase from 100,000 in 2011-12 to 1.3 million across England in 2015-16. That is almost 14% of all ambulance call-outs going to people who did not request an ambulance in the first place—people such as my constituent Gemma. She suffered abdominal pain and called 111 for an out-of-hours doctor to come and see her. Even though Gemma told the call-handler that if she needed to get to hospital she would drive herself there, they still sent an ambulance to her. Gemma was diagnosed with gallstones, and next time she had an incident and needed pain relief urgently she again called 111 to tell them that she knew what the problem was and to ask for a prescription. Instead, they again insisted on an ambulance and would not accept a refusal. Gemma actually drove herself to A&E because she was so determined not to use ambulance time.

The ambulance service says that it is not allowed to reassess 111 calls that have been allocated for an ambulance response, so even if it expects that it is not necessary, it cannot use its expert clinicians to provide the telephone advice and decide whether an ambulance is really necessary. I will get on to the question of resources shortly, but besides resources, my local paramedics have asked whether the ambulance service can reassess 111 calls that it is given if it is in any doubt. I put that question, from them, to the Minister.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 6th February 2018 Commons Chamber

[Jackie Doyle-Price]

The hon. Lady is quite right to press me on these issues. Clearly, there is going to be ongoing trauma, and we need to pay attention to that and make sure that there are adequate resources. I can assure her that this is very high on the list of priorities for the ministerial group. We have committed £23.9 million of national Government funds to address survivors’ needs, with additional expenditure on wider support. The autumn Budget committed a further £28 million to help support victims. I can also assure her that I am in regular contact with Central and North West London NHS Foundation Trust to make sure that we are doing our bit to address this need.

[Melanie Onn (Great Grimsby) (Lab)]

2. If he will make an assessment of trends in the time taken between referral and treatment for patients at hospitals in Northern Lincolnshire and Goole NHS Foundation Trust in the past 12 months.

[The Minister of State, Department of Health and Social Care (Stephen Barclay)]

In the past 12 months, the average waiting time for patients to start consultant-led treatment at hospitals in northern Lincolnshire and Goole was about nine weeks. We recognise that some trusts face particular challenges with their waiting lists due to rising demand. That is why a package of support, including a system-wide improvement board, has been established within the trust.

[Melanie Onn]

The statistics that the Minister has given are very interesting. The Library has said that there is an average wait of 32 weeks—far longer than the nine weeks that he mentioned—and that it is six weeks longer in 2017 than it was in 2016. This is happening on his watch. What is he going to do? My constituents do not accept that it is good enough.

[Stephen Barclay]

I think the hon. Lady prepared her follow-up before hearing the answer. There is an improvement board established within the trust, chaired by NHS Improvement, that is tasked with reducing waiting times and ensuring that the standard is improved. Currently, the average time waited is 11 weeks for out-patients and seven weeks for in-patients.

Hospital Car Parking Charges

Melanie Onn Excerpts

Thursday 1st February 2018 Commons Chamber

[Melanie Onn (Great Grimsby) (Lab)]

I am very grateful to be able to take part in this important debate. I congratulate the right hon. Member for Harlow (Robert Halfon), my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy), and my neighbour, the hon. Member for Cleethorpes (Martin Vickers), on securing it.

Diana, Princess of Wales Hospital in my constituency provides a range of helpful wellbeing services. The site has an A&E, a dialysis unit, a child development unit, a nursery, an eating disorder unit, and health education spaces. It covers a huge range of services that deliver to a very wide community. There are two main areas that I want to address: first, the difficulties and challenges for patients caused by ever-increasing parking tariffs; and, secondly, car parking issues for staff, which have been raised with me on a number of occasions when I have been at Grimsby’s hospital.

In Grimsby, I can go and park in the Iceland car park, in the centre of our town, for £1 an hour. If I need to park for more than two hours, I might go to the Abbey Walk multi-storey, again in the centre of town, and pay £3.50 for the privilege of four hours’ parking. Having worked in places like York, I know that I should be very grateful for the seemingly small amounts that it costs to park in the centre of our town, so I count my blessings. When those smaller amounts are set against what people are expected to pay in hospital parking charges, it feels very much to my constituents as though the NHS is over-inflating the expense and putting an unnecessary burden on patients and families.

The charge for an hour’s parking at Diana, Princess of Wales Hospital has recently increased to £2.10— £1.10 more than in the centre of our town. If I go to the hospital to pick up a prescription, it might take—on a good day, admittedly—just a few minutes to collect the prescription, but on top of the prescription cost, I am paying another £2.10 to do so. Last week, I went for a blood test. I walked in, got my ticket, checked on the screen, and saw that there was a wait of about 68 minutes. It took me a matter of minutes to get the blood test, but the sitting in the waiting room lasted about 68 minutes. The cost of that visit was therefore £3.50. I am not bemoaning the cost to my personal pocket. I can afford it, but many in my constituency cannot, and the cost is prohibitive.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Does my hon. Friend agree that, as well as the issues that have been raised powerfully so far, the example she gives shows the opportunity for greater flexibility? In Hounslow, for example, free half-hour parking has been introduced to support local businesses. It is the same for leisure centres. We need to be proportionate as we consider the overall issue, and that is what was can do today.

[Melanie Onn]

My hon. Friend raises an important point. There is room for flexibility, and all trusts should be looking at what they can do to make parking less prohibitive so that people are not put off.

It is galling for my constituents to know that parking charges are much lower in other areas of the town. Local authority car parks, shops and private parking companies all have the same issues of maintenance, lighting and security, albeit to different degrees, but they are not charging that high rate. It feels very much like profiteering off the back of people who have no choice but to be at hospital, whether that is for themselves, their friends or their relatives. The trust offers concessions through lower costs for blue badge holders, although they are not exempt from charges, as well as for parents who are staying overnight with poorly children and those having cancer treatment. That is, of course, incredibly welcome. However, when the justification for the charges is that they pay for the maintenance of the site, it really does not stack up, given the costs of other paid parking sites in the town.

An automatic number plate recognition system was recently installed at the Diana, Princess of Wales Hospital, which led to even more frustration and concern for constituents. While that fantastic new automated system was supposed to make the process a lot quicker and easier for people, all it did was to cause additional delays and costs. After spending time in the waiting room, as I had to, people had to come out to try to pay for their parking with the new machines. It caused absolute havoc, and there were queues going around the block, and people ended up tripping over into the next pay band and paying even more. The process caused an extraordinary amount of frustration and reflected very poorly on the trust, which is a real shame.

The knock-on effect of the charges is that surrounding streets, such as Second Avenue, Edge Avenue and Limetree Avenue, which are all residential streets with limited on-street parking, get filled with the cars of patients, staff and people attending the hospital. I know that there is nothing illegal about that. There is nothing wrong with people parking in those residential streets, but it really irritates residents if a parked car crosses a dropped kerb or impinges on people’s driveways. That is not only incredibly frustrating, but it gives rise to increased concerns about road safety, especially in school hours.

The right hon. Member for Harlow addressed very well the broader point that people with disabilities or long-term illnesses are generally financially worse off than the rest of the population. The additional cost represents a significant inconvenience and potential hardship for people who can least afford it.

Hospital staff have increasingly been talking to me about this issue. There have been discussions with staff about increasing the amount that they already pay to go to work. An increase has been postponed for now, but the opportunity for it to be brought back next year is, I understand, very much on the table, and the increase will be significant. As the right hon. Gentleman indicated, the people affected will be not just consultants or senior executives who might be earning a very good wage. We are also talking about porters, healthcare assistants and medical secretaries—all the people behind the scenes who keep the hospital going—being expected to pay even more.

The frustrations for staff are immense. They say that they already struggle to get a parking space, not least because some shifts overrun. The likelihood that someone might do an eight-hour shift in the NHS at the moment is frankly negligible. Most people, through their own good will, are giving more to the NHS and working beyond their shift. They do not want to leave their patients in the middle of an incident. The number of parking spaces available is therefore reduced, and people are leaving home an awful lot earlier—an hour to an hour and a half earlier—than their shift starts, which increases their working day immensely.

Most of this is not just about travel time. I know that the roads are congested around the Diana, Princess of Wales Hospital, but that is not the only issue. There is also the problem that people are driving around car parks trying to find a space. It is incredibly frustrating that people are paying for a space at work and cannot get one, and sometimes that is even making them late for work.

[Royston Smith (Southampton, Itchen) (Con)]

The hon. Lady makes a very good point about congestion, with people trying to find parking spaces and there not being enough. Would a compromise be for hospitals to charge a reasonable flat rate, rather than abolishing charges completely, which would exacerbate the very situation she is describing?

[Melanie Onn]

That is certainly worth looking at. We need a system that does not put people off attending their appointments, and that certainly does not prohibit people going to work or cause them to arrive late. Any suggestions that would allow us to reach a sensible solution would be very welcome.

Finally, I will conclude by saying that all car parking charges should be set in the context of a long-term transportation plan that includes park and ride systems, as well as increasing people’s ability to use public transport, cycles and everything else. The reality is that not enough has been done on any of those things to enable people to use alternative methods of transport that will get them to work at the time they need to be there, or to appointments at the time they need them, so it has all been for nothing. The charges are incredibly prohibitive because no other methods of easy, regular transport suit the patients and the staff.

Patient Transport Services: Northern Lincolnshire

Melanie Onn Excerpts

Tuesday 16th January 2018 Commons Chamber

[Andrew Percy]

It is saddening that the same experiences are happening just across the river in the city of Hull as well. This appears to be a consistent theme wherever this company provides ambulance transport services. Unfortunately, the hon. Lady describes an experience that many of my constituents have shared.

In fairness to the north Lincolnshire clinical commissioning group, it has, through the scrutiny processes at North Lincolnshire Council, effectively put the company on notice and informed it that the service is not good enough. Despite that, the improvements have not happened.

[Melanie Onn (Great Grimsby) (Lab)]

I thank the hon. Gentleman for giving way. It is fair to say that all our constituents have suffered for reasons that Thames Ambulance Service Ltd has brought on itself to some extent. It has decided not to pay volunteer drivers, who have been the backbone of the service for some time, to travel to and from where patients must be collected. That means that it has lost 40 of those volunteer drivers. Should it not be rewarding the people who have been the backbone of the service rather than treating them that shoddily?

[Andrew Percy]

I could not disagree with a word the hon. Lady said. She has stolen my thunder—[Interruption.] No, it is good! I was going to come on to the company’s treatment of volunteer drivers. Not only has it said that it will not pay them for mileage unless a patient is in the vehicle, but at three months’ notice it told them that if their vehicles were more than five years old, they could no longer be volunteer drivers. Despite that having been its policy for a considerable time, a company cannot give volunteers three months’ notice like that—say, effectively, “Change your vehicle or give up on the service.” Through its own actions, the company has made an already struggling service much worse. It has absolutely brought the situation on itself.

I have dealt with the issue of volunteer drivers, and I thank the hon. Member for Great Grimsby (Melanie Onn) for raising it. I want to give a couple of examples from my constituency to demonstrate how poor the service has been. One of my constituents in Brigg was given short notice that their transport was to be cancelled because there were no ambulances. That meant that this person, who suffers from mobility issues, had to cancel an important scan. It is impossible for them to get in or out of vehicles unless they have been specially arranged.

The mother of another constituent from Crowle on the Isle of Axholme is 87 years old; she suffers from dementia, is partially sighted and has been repeatedly left stranded following appointments arranged way in advance. My constituent has completely lost trust in the service and family members have had to take time off work to ensure that the lady gets to hospital. The service is there to ensure that that does not have to happen. The situation is completely unacceptable.

Another constituent from the Isle of Axholme has repeatedly been left stranded and unable to book an ambulance. They have been forced to use expensive taxis, which meant that the trip doubled in length. On one occasion the service failed to fulfil a pick-up arranged in advance, and that again required them to use a taxi. The service is totally unacceptable.

--- Later in debate ---

[Andrew Percy]

That is absolutely right. There is an argument for saying that those who provide the emergency services—East Midlands Ambulance Service in the case of Scunthorpe—are better able to provide the patient transport services, just as in Goole we would want Yorkshire Ambulance Service to provide the patient transport. There seems to be some sense in that, unless it is a very strong local community transport organisation that we know we can trust. Yes, there are always examples of failure, but we did not have this recurrent theme of failure under the previous system.

[Melanie Onn]

rose—

[Andrew Percy]

I will give way to the hon. Lady, but then I want to give the Minister enough time to respond.

[Melanie Onn]

I thank the hon. Gentleman for giving way; he is being very generous this evening. Following on from the point made by my hon. Friend the Member for Scunthorpe (Nic Dakin), our local hospital trust is already in special measures—it has gone into special measures for the second time—and senior board members are raising Thames as a potential difficulty and challenge in their efforts to meet their key performance indicators and get out of special measures. This is something the Government need to take really seriously.

[Andrew Percy]

It is incredible that what is judged to be a failing trust has a failing transport patient service that is making it even more difficult for it to get out of special measures. That is another reason I brought this matter to the House today.

Following on from the intervention of the hon. Member for Scunthorpe (Nic Dakin), one of my requests is to the Department for Transport—so not directly in the gift of the Minister in the Department of Health and Social Care—which is currently undertaking a transport accessibility consultation. It might be sensible if the issue of patient transport were to be wound up as part of that. That is one of my asks. I know that the Minister cannot respond, as it is not her Department, but it would be useful if she could pursue it interdepartmentally.



I want to give the Minister enough time to respond, so I will not say much more, but the concerns that I have described are shared by the clinical commissioning group, which has raised these issues with North Lincolnshire Council’s health scrutiny panel on a number of occasions and has told the panel that there will be further sanctions if the service does not improve. Sadly, that was said at the end of October, and, as other Members’ interventions have made clear, there has been no turnaround since then.

--- Later in debate ---

[Caroline Dinenage]

Of course, we have devolved this matter locally and it is up to the local CCG to take action. I know that a recovery plan is in place and the delivery of the plan is now being monitored weekly, but the hon. Gentleman is right, and, like my hon. Friend the Member for Brigg and Goole, he has kept on articulating this issue and asking these questions on behalf of his constituents, to try to find out when they will see a visible difference to the service, because it is currently not good enough.

Patient transport providers are also required to be registered and inspected by the Care Quality Commission, the independent regulator of health services. This Government have given the CQC more powers, and it is now able to rate independent healthcare transport providers in the same way as NHS ambulance services. We fully support the CQC in its work to ensure that users of patient transport services are protected, and where services are not good enough and the necessary improvements have not been made, it can take further action, including issuing fines, service restrictions, and ultimately the cancellation of a provider’s registration.

Additionally, we are very supportive of the Department for Transport-led total transport initiative, which I think was what my hon. Friend the Member for Brigg and Goole was referring to, and which is currently piloting the joint commissioning of public sector-funded transport in order to reduce the risk of services overlapping, improve efficiency, and provide a better overall service to passengers.

From the local work carried out so far, it has become clear there are a range of potential benefits for the NHS, including helping to avoid bed blocking—where patients sometimes cannot go home because non-emergency patient transport is not available—and improving access to NHS services by reducing missed appointments due to late or unavailable transport. We have asked NHS England to ensure that CCGs are all engaging in this important work.

[Melanie Onn]

I welcome the Minister to her new role and wish her the best of luck, but from what she is saying I am not entirely clear how the Government will follow up and pressure will be brought to bear on the CCGs in the delivery of the contract. I had a 97-year-old lady, whom the new chief executive of the Diana, Princess of Wales Hospital and the Northern Lincolnshire and Goole NHS Foundation Trust met. She had had to wait for eight hours in the emergency care centre for transport to go home. There needs to be a little more urgency in the Minister’s response.

[Caroline Dinenage]

I completely understand why the hon. Lady is articulating that; every one of these incidents is absolutely unacceptable and in many cases very distressing. The issue with devolving such clinical decisions to local areas, however, is that we have to allow the CCG to take the necessary steps to ensure the service is put back on to a better footing.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 19th December 2017 Commons Chamber

[Jackie Doyle-Price]

I thank the hon. Gentleman for his support. The figures from Wales come at an early stage, but the system that we are looking to introduce has much in common with that in Spain. The issue is not so much about the register moving towards an opt-out system, but the wraparound care that goes with it, such as the specialist nurses who speak with relatives when they are going through the trauma of losing a loved one, and the public debate that raises awareness. Taken together, they are what will lead to more organs becoming available.

[Melanie Onn (Great Grimsby) (Lab)]

2. What steps he is taking to ensure that information on group B streptococcus is available to NHS patients.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

As the Secretary of State has set out, our ambition is for the NHS to be the safest place in the world to give birth. Information on prevention and the implications of a group B streptococcus infection is available on the NHS Choices website. Just today, the Royal College of Obstetricians and Gynaecologists published a new patient information leaflet that, from the new year, will be given to all pregnant women for the first time. Because it is Christmas, I have a copy here for the hon. Lady. [Interruption.] I see she has one, too.

[Melanie Onn]

I thank the Minister—he has anticipated my question. I reassert that, on average, two babies die each month from complications relating to group B strep. Awareness of the effects of that infection is incredibly low. Will the Minister meet me and Group B Strep Support to discuss how we can get this leaflet to mums-to-be at the earliest possible stage?

[Steve Brine]

I know this is a subject about which the hon. Lady cares greatly. I would be very happy to meet her and to bring together the people I work with from Public Health England to see how we can make the best of this new leaflet and ensure it is the best and most important Christmas present.

Baby Loss Awareness Week

Melanie Onn Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

Following on from the very moving and courageous speeches by hon. Members about Baby Loss Awareness Week, I rise as someone whose own family members have suffered from the trauma of baby loss. Stillbirths and neonatal deaths affect so many in our community, including in my Slough constituency. The son of my very good friend Councillor Madhuri Bedi was born prematurely. He had strep B, which gave him brain damage. The family had to make the harrowing decision to switch off his life support machine only one day into his precious life. As they remarked, there is very little awareness and not enough support. That is something that we all need to work towards.

I commend the excellent work done by so many individuals, campaigners and hon. Members, on a cross-party basis. I also pay tribute to members of the all-party parliamentary group on baby loss.

[Melanie Onn (Great Grimsby) (Lab)]

On that point, will my hon. Friend join me in welcoming the recommendations in the updated clinical guidance from the Royal College of Obstetricians and Gynaecologists, which include the recommendation that all pregnant women should at the very least be provided with an information leaflet on group B strep, as a tool to raise awareness and prevent what he has just described?

[Mr Dhesi]

I fully concur with my hon. Friend and thank her for her intervention. In that regard, I would very much like to pay tribute to hon. Members in the all-party group. I look forward to joining them tomorrow to provide whatever little support I can.

It is wonderful to see the advances made and also the pledges made by the Minister, whether on maternity safety champions, funding for safety and training at hospitals or the national bereavement care pathway. I for one most sincerely hope that he and the Government will continue in this endeavour to ensure that we make further advances and minimise the trauma suffered by so many.

Incontinence

Melanie Onn Excerpts

Tuesday 5th September 2017 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

Incontinence is not an issue that is often discussed in the Chamber. Society sees the condition as a taboo, which is hidden from public view while sufferers cope in private. However, an estimated 14 million people in all age groups will, at some point in their lives, experience a problem with bladder dysfunction. A further 6.5 million will have bowel dysfunction.

It is generally assumed that incontinence is a condition that affects older people, but that is only half the story. The National Childbirth Trust estimates that almost half of all women experience urinary incontinence after childbirth; there are around 700,000 births a year, so as many as 350,000 women could face this problem. NHS figures suggest as many as 900,000 children and young people experience some form of problem.

More than 300,000 people are diagnosed with ulcerative colitis and Crohn’s, otherwise known as inflammatory bowel disease, and the most common age for diagnosis is between 18 and 30. Those conditions affect the digestive system to different degrees, but one in 10 people will experience regular incontinence. A 2012 survey by Crohn’s and Colitis UK found that 61% of people had not sought medical advice for the incontinence. Like all other conditions that have associated problems with incontinence, that leads to social isolation. Crohn’s and Colitis UK surveyed 1,000 young people on their experience, and 75% said that their condition made socialising impossible because of always needing to know of the proximity to a toilet. On a very simple level, given how many local authorities are closing access to public toilets, is it not time that we looked at alternatives? It is surely not beyond our wit in this House to look at issues such as rate relief, so that hotels, restaurants, pubs and cafes provide access to their toilets for those who urgently need to have it.

[Melanie Onn (Great Grimsby) (Lab)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests. Does my hon. Friend agree that businesses with a high footfall could do an awful lot more to support their customers’ needs in respect of incontinence issues, and consider additional aids such as the Crohn’s and Colitis UK “Can’t Wait” card—a facility to enable individuals who suffer from incontinence issues to access the toilet facilities of businesses that would not ordinarily allow people to use them, but which support their customers as and when they might need it, to avoid any emergency situations?

[Mrs Moon]

I thank my hon. Friend for her work in this area. That most certainly would help, and it is so simple; it is not a huge thing to do. Another example is simply having a shelf in toilets where someone with a colostomy or ileostomy can place the clean bag, so it is readily available while they remove the full bag. That would make things so much easier and healthier, by ensuring there is no cross-infection. Instead, people often have to scrabble on dirty toilet floors, trying to access what they need.

All the figures I have to hand today are estimates—as one patient group pointed out to me, the collection of statistics in this field is patchy at best, and putting a true figure on the scale of the problem is very difficult—but we will not tackle taboos until we start talking about them: we must destigmatise the subject so that no one faces humiliation if they admit to a problem. We need to bring this issue out into the open once and for all, so that people no longer suffer in silence and we can reduce the long-term health implications and additional costs for the NHS.

An analysis of calls to the Bladder and Bowel Foundation’s helpline in 2015 suggested that half the people with a continence problem had never spoken to a healthcare professional. Another study found that only one in three families seek help for children and young people with a continence problem. Imagine the long-term impact on a child’s health of having to try to manage such a problem at school, with all the stigma of being the smelly kid and all the fear of having an accident during a lesson.

--- Later in debate ---

[Mrs Moon]

I commend my hon. Friend’s work for the all-party parliamentary group on continence care, which does invaluable work in this area.

I am going to jump to another section of my speech. It is shocking how many people go into hospital with no continence problems but may be incontinent or doubly incontinent and have major problems by the time they leave. It is far too easy for nurses and doctors to see the use of pads as the only solution. At some point, I hope the Minister will look at how we can gather figures from hospitals on how many patients enter with continence problems and how many leave with continence problems to get some idea of how great the problem is.

I chair the all-party parliamentary group on Parkinson’s, and the Minister will be aware that Parkinson’s UK has campaigned for many years due to the problems that people with Parkinson’s have when they go into hospital and their carefully timed medication regime is changed to fit in with drugs rounds on the ward. A perfectly mobile and continent person can become immobile and incontinent due to NHS failure. That cannot be allowed to carry on. It is shameful that we are facing such problems in 2017.

Diagnoses are not made in a huge number of cases. Healthcare professionals do not provide consistent assessments, diagnosis and follow-through according to standard practice. Even basic things, such as an assessments of where the toilet is in relation to where someone sleeps, are not carried out by social workers. I cannot begin to tell the House how many times people are admitted to hospital as the result of a fall at night caused by them trying to negotiate the stairs to go up or down to a toilet that is on a different level from where they sleep. It is shocking that people face having to wear an incontinence pad because they cannot use the stairs or because there is a risk of them falling at night when accessing the toilet. We simply must get this sorted out.

Incontinence can cause additional problems. Urinary tract infections, pressure sores, anxiety, depression and falls cost the NHS a great deal of money, and we could save money by making relatively simple changes. I have not been able to find any comprehensive analysis of the cost to the NHS and other services that would demonstrate potential savings from early interventions. As far as I am aware, such an assessment has not been carried out. A series of parliamentary questions tabled last year revealed that data are not held by the Department of Health on the number of people admitted to hospital for catheter-associated urinary tract infections, for non-catheter-associated urinary tract infections or with urinary incontinence generally. If it existed, such information would help to clarify the extent of the problem. An estimate was offered in 2014-15, with NHS trusts reporting an annual cost of £27.6 million, which is almost certainly an underestimate.

Too many individuals are bearing the brunt of managing their condition. Buying a regular supply of pads costs anywhere between 10p a pad, for a child, and 60p a pad, depending on the type of pad required.

[Melanie Onn]

My hon. Friend is being generous with her time. Does she think that now is the time for the Government to reconsider the VAT on these products?

[Mrs Moon]

We need to reconsider the issue of VAT on a whole range of sanitary and continence products. As a society, we need to take responsibility for the facts of our daily life. For a person on any sort of restricted income, such as those on benefits, the costs even of simple laundry are huge when dealing with incontinence.

Some families are spending up to £100 a week buying incontinence products. It is ludicrous if they are not able to access those products through the health service or joint stores with local authorities. It is a postcode lottery whether or not a person can access the help and support they need, which is shocking. Think of the savings in sickness pay, in hours of work lost and in mental health and wellbeing if we started to tackle this problem.

It is time to raise a number of issues, including what happens when things go wrong.

Adult Social Care Funding

Melanie Onn Excerpts

Thursday 6th July 2017 Commons Chamber

[Mr Speaker]

What an array of riches! I call Melanie Onn.

[Melanie Onn (Great Grimsby) (Lab)]

One among many, Mr Speaker.

This Government have pushed a national crisis on to hard-pressed local councils and hard-up local residents, forcing council tax rises that will barely cover the minimum-wage salaries paid to carers. The Minister says that the precept has been welcomed, but I would ask: by whom?

[Steve Brine]

The precept is welcomed by local authorities that want to get extra money into their social care system.

[Melanie Onn]

It’s not.

[Steve Brine]

I understand that the hon. Lady wants to play politics with this issue, but as I said in my response to the urgent question, I honestly think that we can do better than that.